AIM Specialty Health (AIM) manages prior authorization for select services for Premera Blue Cross. Prior authorization is required for certain procedures and services. Contracted providers are financially liable for providing services that are medically unnecessary. Providers must make prior authorization requests through AIM for members on plans that require it. Show
Prior authorization is based on member benefits and eligibility at the time of service. It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. The following services are subject to review by AIM:
View the code list to see which codes require review. View AIM Clinical Appropriateness Guidelines. To request a prior authorization, register with AIM and then submit your request online or by phone at 866-666-0776. Prior authorization isn't required for the following:
Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. In addition, servicing providers must submit ordering/referring provider information, per guidelines from the Centers for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. If you have questions, call AIM at 866-666-0776. AIM Resources for Providers
AIM Specialty Health is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. The individual plan website is managed by Evolent Health for Premera and uses tools specifically for patients with individual plans. If a member has an individual plan, their ID card will say Individual Plan. View an example member ID card. View prefix list for Individual Plans. Sign in now Note: Google Chrome is the best browser to use for the individual plan website. News and updates for individual plansIdentifi Access Identifi to submit a prior authorization request. Important: To prevent delays, check the prior authorization code list before submitting a request to see if review is required or should be submitted through AIM. It takes 1-5 business days to process your access to Identifi. If you need to submit a prior authorization during the waiting period, which automatically starts once you've clicked on the link to the Individual Plan secure provider portal, you can fax your submission or call our utilization management team. You can also call the customer service number on the back of the member ID card. You'll receive a confirmation email once you have Identifi access. Individual Prior Auth Tool UpdateAs of June 28, 2021, care notes, phone numbers, and fax numbers are required fields on the Identifi prior authorization tool. Sending refund checks to PremeraA form isn't needed for sending us refund (overpayment) checks. You can submit requests in writing and include the following related to the overpayment:
New code list for 2021Effective January 1, 2021, individual plans will have prior authorization changes. To learn more, view Medical Policy & Coding Updates within the Special notices section or view the 2021 code list effective January 1, 2021. Secure website error messageIf you received the message, "You have successfully logged into the Evolent application, but we do not find the Provider," read these instructions to provide key services to your individual plan patients. Secure member eligibility searchThe member eligibility search doesn’t accept member prefixes. Search by member ID or by the member’s last name and date of birth for accurate results. CMS 1500 online claims submission not availableThe online claims submission tool for HCFA (CMS) 1500 claims currently isn’t available on the individual secure website. In the meantime, submit claims by mail to the address below or through Office Ally. For professional and institutional claims, the claim payer ID is 00430 and for dental claims the ID is 47570. COVID-19 prior authorization updatesCheck out our COVID-19 FAQ for the lasted updates on prior authorization. Training guidesUse the following provider training guides to learn more about our individual plan tools:
Provider resourcesProvider directorySearch for medical providers, facilities, and other specialists within the Premera Blue Cross Individual Signature network. Contact information for individual plansCustomer serviceCall customer service at 800-809-9361 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Customer service can also provide web support and information on member eligibility and benefits. Claims and clinical appeals addressIndividual plan claims, appeals, and other paper correspondence must be sent to: Premera Blue Cross Utilization managementCall 844-966-0332 or fax 888-584-8081 to contact our utilization management team. Use this fax number to submit a prior authorization request. Electronic funds transfer (EFT) and Electronic Remittance Advice (ERA)InstaMed delivers all electronic funds transfer (EFT) payments and electronic remittance advice (ERA) for individual plans. If you submit and receive EFT/ERA through a clearing house, the clearing house needs to sign up for InstaMed. This process is not completed by Premera EDI. Providers should be enrolled with InstaMed and Premera EDI to ensure they receive all Premera electronic remittance reports. Already have InstaMed? Great! You’ll automatically receive EFT payments for our individual plan claims. |
Premera blue cross prior authorization phone number
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